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Is it Anaplastic Thyroid Cancer, Primary Thyroid Lymphoma, or Rosai Dorfman Disease? An Elusive Histopathologic Diagnosis of a Thyroid Mass

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Abstract

The aim of this study is to present an elusive case of primary thyroid lymphoma (PTL), initially thought to be anaplastic thyroid carcinoma, then Rosai Dorfman disease, before the final diagnosis of PTL was made. An elderly female with hypothyroidism presented with compressive airway symptoms secondary to an enlarging neck mass. Imaging was suggestive of undifferentiated thyroid cancer. The initial biopsy was unexpectedly consistent with a lymphoproliferative disorder such as Rosai-Dorfman disease. A repeat biopsy with immunohistochemical analysis yielded a diagnosis of diffuse large B-cell lymphoma of germinal center subtype. The patient was spared thyroid surgery and started on appropriate chemotherapy. PTL is within the differential diagnosis that physicians must consider in a patient with a rapidly-enlarging neck mass. A clinical index of suspicion and early accurate diagnosis may spare the patient from unnecessary surgery that is required of most other non-hematopoeitic thyroid malignancies.

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Authors and Affiliations

  1. Loma Linda University School of Medicine, Loma Linda, CA, USA

    Stephanie Kim

  2. Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA

    Austin L. Gray, Wilson P. Lao, Mia N. Perez & Yan Liu

  3. Department of Otolaryngology – Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA

    Wilson P. Lao & Steve C. Lee

Authors
  1. Stephanie Kim
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  2. Austin L. Gray
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  3. Wilson P. Lao
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  4. Mia N. Perez
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  5. Yan Liu
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  6. Steve C. Lee
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Contributions

All authors contributed to substantially to, and approve of, this manuscript. Conceptualization: SK, WPL. Supervision: MNP, YL, SCL. Writing—original draft: SK, ALG, WPL. Writing—review & editing: MNP, YL, SCL.

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Correspondence to Wilson P. Lao.

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As part of the publishing ethics requirements, this case presentation was approved by the institutional review board of Loma Linda University.

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Kim, S., Gray, A.L., Lao, W.P. et al. Is it Anaplastic Thyroid Cancer, Primary Thyroid Lymphoma, or Rosai Dorfman Disease? An Elusive Histopathologic Diagnosis of a Thyroid Mass. Head and Neck Pathol 16, 507–512 (2022). https://doi.org/10.1007/s12105-021-01392-8

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  • DOI: https://doi.org/10.1007/s12105-021-01392-8

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